1134293244 NPI number — JOHNSON LABORATORY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134293244 NPI number — JOHNSON LABORATORY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON LABORATORY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134293244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSHOCTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-622-3971
Provider Business Mailing Address Fax Number:
740-622-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-3971
Provider Business Practice Location Address Fax Number:
740-622-5150
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEITZEL
Authorized Official First Name:
KATINA
Authorized Official Middle Name:
EILEEN
Authorized Official Title or Position:
OWNER MANAGING SUPERVISOR
Authorized Official Telephone Number:
740-622-3971

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4425812 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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